GENOA HEALTHCARE, LLC (NPI# 1518157049) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518157049 |
| Entity Type | Organization |
| Organization Name | GENOA HEALTHCARE, LLC |
| Practice Address |
17844 E 23rd St S Ste D404 Independence MO 64057-1840 |
| Mailing Address |
Po Box 77030 Minneapolis MN 55480-7730 |
| Practice Telephone | 8168337325 |
| Practice Fax Number | 8168337340 |
| Mailing Telephone | 2532180830 |
| Mailing Fax Number | 2532174306 |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2020-03-20 |
| Authorized Official Name | WILLIAM ROBERT GUPTAIL (COO) |
| Authorized Official Telephone | 6516890258 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | 2007022495 | MO | Suppliers |
| N | 333600000X | Pharmacy | 2007022495 | MO | Suppliers |
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
2007022495 | MO | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | DEA | FG5484972 | 01 |
| MO | BOP LICENSE | 2015006810 | 01 |
| NCPDP | 2637532 | 01 | |
| MO | 606332104 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972103257 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 555 Towner St Ste 1120d, Ypsilanti, MI 48198-5723 | 2020-10-27 |
| 1477153757 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 299 W Railroad Ave Ste P, Crestview, FL 32536-4053 | 2020-10-27 |
| 1033719323 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 7001 Blue Ridge Blvd Ste P, Raytown, MO 64133-5629 | 2020-10-27 |
| 1326648601 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 225 Carlton Davidson Ln Rm 1, Coal Grove, OH 45638-2924 | 2020-10-27 |
| 1912507211 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 5690 Santa Teresita Drive, Suite A2, Room P1, Santa Teresa, NM 88008 | 2020-10-27 |
| 1760080238 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 3807 N 7th St Ste P, Phoenix, AZ 85014-5005 | 2020-10-15 |
| 1174121982 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 807 Lawn Ave Ste 104, Sellersville, PA 18960-1549 | 2020-10-14 |
| 1457959272 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 281 Laclair St Rm 135, Coos Bay, OR 97420-2988 | 2020-10-14 |
| 1811595622 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 2500 W Washington Ave Ste 103, Las Vegas, NV 89106-3731 | 2020-10-14 |
| 1245844000 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 1441 E 84th Pl Rm 120, Merrillville, IN 46410-6578 | 2020-08-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Washington State Corporations | GENOA HEALTHCARE, LLC | 18300 Cascade Ave S # 251, Tukwila, WA 98188 |
| Massachusetts Corporations | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Ohio Business Entities | GENOA HEALTHCARE, LLC | 510 East Main Street, Auburn, WA 98002 |
| Vermont Business Registrations | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Connecticut Business Registrations | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Indiana Business Entities | GENOA HEALTHCARE, LLC | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 |
| Colorado Business Entities | GENOA HEALTHCARE, LLC | 18300 Cascade Ave S. Suite 251, Tukwila, WA 98188-4746 |
| Street Address |
17844 E 23RD ST S STE D404 |
| City | INDEPENDENCE |
| State | MO |
| Zip Code | 64057-1840 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174002364 | Justine Barye Bolton | Physical Therapist | 2301 South 291 Highway, Independence, MO 64057 | 2018-08-09 |
| 1194230136 | Brantley Vincent Niendick | Occupational Therapist | 2301 S M 291 Hwy, Independence, MO 64057 | 2017-12-13 |
| 1437693561 | Derek Faulkner | Counselor | 2400 Little Blue Pkwy, Independence, MO 64057 | 2016-12-08 |
| 1578916136 | Jared Donald Gerstenkorn | Physical Therapist | 2301 South Highway 291, Independence, MO 64057 | 2016-07-19 |
| 1295198182 | Jennifer J Allen | Nurse Practitioner | 2310 Castle Drive, Independence, MO 64057 | 2016-03-30 |
| 1750750808 | Lisa Louise Freeman | Physical Therapy Assistant | 3980 S Jackson Dr, Independence, MO 64057 | 2015-09-18 |
| 1437543592 | Harold Epps | Specialist/Technologist | 2301 South Mo 291 Highway, Independence, MO 64057 | 2015-03-26 |
| 1245620426 | Holly Morgan | Occupational Therapist | 3980 S Jackson Dr., Independence, MO 64057 | 2015-01-27 |
| 1093128159 | Jennifer Falk Crumbaugh | Dentist | 3151 S. M-291 Highway, Suite A, Independence Mo, MO 64057 | 2014-06-06 |
| 1952711954 | Judy Bray | Occupational Therapy Assistant | 3980 East Jackson Drive, Independence, MO 64057 | 2014-04-30 |
| Find all providers in zip 64057 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699093872 | Genoa Healthcare, LLC | Pharmacy | 3751 W Main St, Independence, KS 67301-8446 | 2010-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265033534 | Good Graces, LLC | Pharmacy | 857 E Main Street, Ste 3 - 5, Willow Springs, MO 65793 | 2020-11-03 |
| 1780298406 | Healthdirect Institutional Pharmacy Services, Inc. | Pharmacy | 4083 N State Highway Nn, Ozark, MO 65721-7201 | 2020-09-01 |
| 1023620838 | Tipton Pharmacy | Pharmacy | 310 Us Highway 50 W, Tipton, MO 65081-8701 | 2020-08-21 |
| 1568095313 | Auburn Pharmacy, Inc. | Pharmacy | 1103 S 169 Hwy, Smithville, MO 64089 | 2020-02-20 |
| 1780229690 | Dalpoas Group Inc | Pharmacy | 4245 Forest Park Ave Ste B, Saint Louis, MO 63108-2810 | 2019-11-14 |
| 1053953109 | Summers Pharmacy of Slater, LLC | Pharmacy | 102 E Maple St, Slater, MO 65349-1539 | 2019-10-10 |
| 1316594328 | Legacy Drugstore LLC | Pharmacy | 13000 Veterans Memorial Pkwy Ste A, Wright City, MO 63390-1012 | 2019-08-23 |
| 1972158673 | Hils Pharmacy Salisbury LLC | Pharmacy | 501 E. 24 Hwy Ste A, Salisbury, MO 65281 | 2019-08-08 |
| 1700342888 | Battlefield Pharmacy | Pharmacy | 4062 W Republic Rd, Battlefield, MO 65619-7108 | 2019-02-14 |
| 1548733769 | Guardian Pharmacy of St. Louis, LLC | Pharmacy | 926 S Highway Dr, Fenton, MO 63026-2023 | 2019-01-10 |
| Find all providers with the same taxonomy | ||||
| City | INDEPENDENCE |
| Zip Code | 64057 |
Please comment or provide details below to improve the information on GENOA HEALTHCARE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.